Development of a Prolonged Opioid Prescribing Electronic Clinical Quality Measure

Avery Pullman, BS
Department of Medicine
Poster Overview

Long term opioid prescriptions after hip and knee surgery can be harmful. They can lead to dependence and greater use. This can cause brain damage and even death. Therefore, finding a way to make sure that prescription lengths are safe is important. We developed a tool to study opioid prescription length after surgery. We focused on patients who had a total hip or knee surgery since these are common and painful surgeries. We used a guideline that recommends the opioid prescription length after hip and knee surgery. Then, we examined how many patients received opioids for longer than that length. This showed that there is room for improvement how opioids are prescribed. Experts reviewed our data and agreed. Next, we will perform tests at a different site to determine if our tool continues to perform as expected.

 

Scientific Abstract

Background: Long-term prescriptions of opioids by surgeons to manage acute post-operative pain has been acknowledged as a potential contributor to the current opioid epidemic. The goal in developing this eCQM is to evaluate and improve physician prescribing practices following total hip (THA) and/or total knee arthroplasty (TKA).

 

Methods: Utilizing a guideline developed by the Washington State Agency Medical Directors group in 2018, we defined ‘prolonged prescribing’ as opioid prescriptions that exceeded 42 days (6 weeks) following surgery. This measure was then tested on 12,803 Mass General Brigham (MGB) THA/TKA patients to determine the rate at which patients were prescribed opioids over the recommended duration at the clinician group level.

 

Results: Of the 3,533 THA patients tested, 3.7% received demonstrated a “prolonged use” or opioids. Meanwhile, of the 5,058 TKA patients, 12.1% demonstrated “prolonged use”. This produced an overall risk-adjusted MGB rate of 8.58% across all clinician groups. When examining the data at the clinician group level, significant variability was noted between the 6 MGB sites, with results ranging from 7.4% to 12.5%.

 

Next steps: We will be receiving data from a geographically distinct Healthcare System soon. This data will address the generalizability of the measure.

Clinical Implications
This measure seeks to improve opioid prescribing practices following THA/TKA, decreasing the risk of opioid abuse and dependence. Additionally, this measure will improve interoperability and decrease burden by allowing clinicians to compare their performance via routinely captured data elements.
Research Areas
Authors
Avery Pullman; Ania Syrowatka; Woongki Kim; Troy Li; Stuart R. Lipsitz; Michael Sainlaire; Wenyu Song; Tien Thai; Patricia C. Dykes
Principal Investigator
David W. Bates

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